Dive Brief:
- Cigna is the latest health insurer to roll back prior authorization requirements, announcing Thursday that it will no longer require the approvals for nearly 25% of medical services.
- Cigna plans to remove more than 600 prior authorization codes in its commercial plans, bringing Cigna’s total prior authorization removals to more than 1,100 since 2020, the payer said.
- Cigna plans to nix another 500 or so codes for its Medicare Advantage plans before the end of this year.
Dive Insight:
Prior authorizations require physicians to get the green light from a patient’s health plan before prescribing certain medication or undergoing some non-emergency medical procedures. Payers say prior authorization is a necessary evil to curb medical costs, while providers decry it as another bureaucratic hoop they’re required to jump through before providing care.
With Cigna’s new cutback, fewer than 4% of procedures are now subject to prior authorization for commercial policyholders, according to the company, which covers 16.5 million commercial enrollees.
“We've listened attentively to our clinician partners and are deliberately making these changes as a result,” Cigna Chief Health Officer David Brailer said in a statement.
Cigna is removing prior authorizations for more than 100 surgical codes and nearly 200 genetic testing codes, along with a range of durable medical equipment, orthoses and prosthetics, spokesperson Justine Sessions told Healthcare Dive.
A number of payers have recently rolled back prior authorization requirements as the federal government takes steps to streamline the process, following rising patient and provider criticism that prior authorizations are bottlenecking care.
CVS-owned Aetna rolled back prior authorization requirements on cataract surgeries, video EEGs and home infusion for some drugs last year.
In March, UnitedHealthcare said it planned to remove nearly 20% of prior authorizations. A few months later, the health insurer — the largest private payer in the U.S. — also nixed a plan to require prior authorization for colonoscopies and other endoscopic procedures following backlash from doctors.
The cuts come amid increasing regulatory and congressional interest in streamlining prior authorizations.
The CMS proposed a rule late last year that would require health insurers to automate prior authorization and return decisions more quickly. Another rule finalized in April cracks down on overuse of utilization management policies like prior authorization in Medicare Advantage.
Congress is also considering legislation that would require MA payers to consider requests for prior authorization electronically and make decisions more quickly for routinely approved items and services.
Some states have also moved to ameliorate prior authorization burden on doctors.
Pennsylvania, for example, requires commercial insurers and Medicaid plans to provide a more streamlined approval process for non-urgent and emergency services, while Texas exempts doctors with a 90% prior authorization approval rate for certain services from prior authorization requirements.
